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Juvenile Idiopathic Arthritis: Pain Management

Topic Overview

Most children who have
juvenile idiopathic arthritis (JIA) will have some
pain and discomfort from the disease. The pain of JIA is related to the type
and severity of the disease, the child's pain threshold, and emotional and
psychological factors. Pain limits a child's ability to function. With care and good communication with your child's doctor, it
is possible to provide some, if not total, relief.

How to know if your child is in pain

Pain can be difficult for a child to describe. Also, a child
isn't always able to recognize a sensation as pain. An older child may be able
to describe tingling, cramping, or sharp sensations and may be able to tell
where and when the sensation occurs. When a young child is in pain, the signs
can be hard to recognize.

Signs that may mean your child is in pain
include:

Changes in usual behavior. Your child may eat
less or become fussy or restless.

Crying, grunting, or
breath-holding.

Crying that can't be comforted.

Facial expressions, such as a furrowed brow, a wrinkled forehead,
closed eyes, or an angry appearance.

Sleep changes, such as waking
often or sleeping more or less than usual. Even children in severe pain may
take short naps because they are tired.

Body movements, such as
making fists, guarding a part of the body (especially while walking), kicking,
clinging, or not moving.

Some children may deny that they are in pain because they are afraid of
medical procedures. For example, admitting that they are in pain might mean blood tests, which may be painful themselves. Some children may try
to ignore their pain rather than take medicines, which often have
discomforting side effects. Pain isn't a visible
symptom, so you and your child's treatment team will need to rely on your
child as the primary source of information on the status of his or her pain.
Only your child knows if pain is present. And experts say that children rarely
pretend to have pain.

Managing your child's pain

Your child's JIA treatment plan should include regular assessments of
pain and what to do to relieve it, starting with medicines such as
nonsteroidal anti-inflammatory drugs (NSAIDs). Pain, stiffness, and swelling can change in intensity from day to day. So be sure to learn how to assess your child's condition, which often requires
being sensitive to signs of pain on a daily basis.

The following may help relieve some pain:

Therapists can teach your child techniques to deal with pain or pain-causing
times. These techniques include distraction, humor, relaxation exercises, and
allowing the child to have some control over what is happening to him or her.
Cognitive-behavioral therapy is another way for your
child to learn positive techniques for dealing with pain.

Heat can be a great reliever of pain for your child. Taking baths can
provide soothing moist heat, and hot packs set on a low-to-medium
setting can be applied off and on throughout the day and night. Do not use heat if your
child's joint are red and warm. If
you have access to a swimming pool, you may want to try pool therapy, which
provides an inviting environment for exercises.

Exercise can help with pain, but don't allow your child to overexert while exercising. Encourage your child to
attend school, even at times of discomfort, but work with the school to make
your child's special needs an accepted part of the routine.

Distraction can take your child's mind off of the pain. Having conversations with or reading to your child can give your child something to focus on besides the pain. Doing fun activities with your child can also help.

Your child's pain may be more manageable if he or she is in good
general health. Children with JIA need more
rest, such as frequent naps or quiet periods, than
most other children do. This increased time devoted to rest, coupled with the
side effects of some medicines, can lead to a weight problem. Offer a
balanced diet to your child, and don't neglect your health and that of your
other family members. You are all in this together.

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